sole of the foot. The affected
glands nearly always break down and suppurate, and after destroying the
overlying skin give rise to fungating ulcers. The treatment consists in
excising the glands and the affected skin. The dissection may be
attended with troublesome haemorrhage from the numerous veins that
converge towards the femoral trunk.

Tuberculous disease in the _mesenteric_ and _bronchial glands_ is
described with the surgery of regions.

#Syphilitic Disease of Glands.#--Enlargement of lymph glands is a
prominent feature of acquired syphilis, especially in the form of the
indolent or bullet-bubo which accompanies the primary lesion, and the
general enlargement of glands that occurs in secondary syphilis.
Gummatous disease in glands is extremely rare; the affected gland
rapidly enlarges to the size of a walnut, and may then persist for a
long period without further change; if it breaks down, the overlying
skin is destroyed and the caseated tissue of the gumma exposed.

#Lymphadenoma.#--_Hodgkin's Disease_ (Pseudo-leukaemia of German
authors).--This is a rare disease, the origin of which is as yet
unknown, but analogy would suggest that it is due to infection with a
slowly growing micro-organism. It is chiefly met with in young subjects,
and is characterised by a painless enlargement of a particular group of
glands, most commonly those in the cervical region (Fig. 80).

[Illustration: FIG. 80.--Chronic Hodgkin's Disease in a boy aet. 11.]

The glands are usually larger than in tuberculosis, and they remain
longer discrete and movable; they are firm in consistence, and on
section present a granular appearance due to overgrowth of the
connective-tissue framework. In time the glandular masses may form
enormous projecting tumours, the swelling being added to by lymphatic
oedema of the overlying cellular tissue and skin.

The enlargement spreads along the chain of glands to those above the
clavicle, to those in the axilla, and to those of the opposite side
(Fig. 81). Later, the glands in the groin become enlarged, and it is
probable that the infection has spread from the neck along the
mediastinal, bronchial, retro-peritoneal, and mesenteric glands, and has
branched off to the iliac and inguinal groups.

Two clinical types are recognised, one in which the disease progresses
slowly and remains confined to the cervical glands for two or more
years; the other, in which the disease is more rapidly disseminated and